How to Choose a Medical Specialty: What to Avoid

“I love the hours.” “I want to be just like Dr. Smith. He has a sweet practice.” “I want to make a ton of money.”

These are some bad reasons why medical students choose a specialty. Most medical students decide what specialty to pursue when they are in their mid to late 20s. While we all think we are pretty wise and informed by that time, often we are fairly immature in our thinking and don’t fully consider the “big picture” when deciding what we are going to do for the remainder of our lives and careers. Medical students can also be in a proverbial ‘bubble” during medical school, busy studying and spending long hours in the hospital, with little time outside of the “medical world.” This, too, can lead to a warped perspective that doesn’t involve the “real world” or consideration of what life might be like after training. Let us discuss how to choose medical specialty. In deciding on a specialty, do not base your decision on “bad reasons,” which include more than those above:

You want to make a lot of money. Maybe you also want to join a field with “status.”

Most medical students have loans and therefore have a practical reason for a high-paying specialty choice. However, as you have likely heard before, money alone won’t make you happy. You will be practicing your specialty for the rest of your life and even if you decide to become a plastic surgeon because of the big bucks often associated with the practice, if you don’t enjoy the types of procedures and patients it entails, you might be miserable despite your big bank account. I had one student who was eager to have a big home, take fancy vacations, and generally live a life of luxury. After doing his research and seeing all of the glossy ads in local magazines for cosmetic surgeons, he realized this would be a great choice to reach his goals. He shadowed a community doctor who had a thriving cosmetics practice and performed many cosmetic surgeries, botox, and other “beauty enhancements.” After shadowing this doctor for a week, the student decided he would not enjoy caring for this patient population. However, he reasoned that he could ‘deal’ with it if he was making a lot of money since he could spend his leisure time as he wished. However, after considering that most of his waking hours would be spent in the operating room or the office, he realized that perhaps he should consider another specialty.

By the same token, many medical school students are, by nature, very competitive and want to join a specialty that has a “wow factor.” They are concerned – will people be impressed when they hear what I do? Will I be saving lives? Status alone won’t carry you through a long career. You must, at a very basic level, enjoy the work you do. Also, as you mature, your values may change. In your late 20s, spending long hours in the hospital may seem glamorous and appealing, but as you get older and have family and other responsibilities you may not want to work as intensely as some specialties demand.. Keep in mind that stereotypical heroic specialties such as neurosurgery, emergency medicine, trauma surgery, and oncology often require a tremendous amount of emotional stamina, leaving little for your personal life.

You love the hours and want a specialty that is “easy.”

Many students choose a specialty thought to have ‘easy hours.’ The fields that come to mind are the E-ROAD specialties – emergency medicine (EM), radiology, ophthalmology, anesthesiology, and dermatology. The hours related to these specialties often aren’t that “easy, however.” Anesthesiologists, for example, routinely wake up at about 5 AM because operating rooms open early. Even though full-time emergency physicians put in about 35 – 40 hours per week, they work odd hours – evenings, nights, and weekends. Emergency physicians often spend their “off time” recuperating or “bouncing back” from late shifts. Odd hours can take a toll in the long term, something that’s difficult to understand when you are young. One student, who was always a night owl, considered a career in EM, figuring that she could “handle” the circadian rhythm disturbances. But, after doing her EM rotation, she saw how wiped out some of the attending physicians were and decided this would not be the best long term choice for her overall health and well being.

You were impressed by someone in a particular specialty, and you want to be just like that person.

You are on your surgery rotation and you meet a person who represents the type of physician you want to be in the future. She is swift in the OR and deals with unexpected complications with aplomb. Yet she is also kind, compassionate, and deeply invested in her patients and their outcomes. She is also a real team player who treats everyone on her team with warmth and support. You want to be like her when you grow up so you decide to meet with her to discuss the idea of becoming a surgeon. At that meeting, she tells you that working in academic medicine has many demands. She must publish, participate in hospital committees, teach, do research, and attend grand rounds even when not presenting. You tell her that all you hope to do is practice community medicine so she suggests you gain exposure to the field of surgery “in the community.” During your winter break, you shadow a community surgeon. The work doesn’t seem nearly as exciting as the work in an academic setting. The surgeon has busy, but lonely, days filled with OR time, outpatient visits, and administrative work. Confused, you consider what other specialties might interest you.

During medical school, most of the people you meet and your clinical rotations will take place in academic hospital settings. Yet the majority of medical school graduates will not practice in these arenas; most will practice in community settings. The reality is that specialties are practiced very differently in different settings, and many students select a specialty based on their understanding of how it is practiced only in an academic medical setting. It is important, when you meet ‘the doctor you hope to become,’therefore, to be sure to really talk to her, find out exactly what her career entails, and “test out” your specialty in those settings in which you are most likely to practice.

You don’t really want to practice the specialty you are choosing or you plan to practice for only a short time.

I sometimes hear students say, “Well, I don’t really want to practice that specialty. My goal is to get out of clinical medicine or just practice one part of the specialty.” For example, some students think if they pursue EM, they can graduate and just work day or urgent care shifts. Or, someone may pursue a residency in several disciplines with the intent of gaining clinical experience and then “going into industry.” Others may choose a specialty that would make them a good candidate to become talk show hosts. While some people are successful when pursuing careers that are tangentially or barely related to medicine, most are not. If you know as a premedical or medical student that you really don’t want to practice medicine, perhaps you should give your medical school seat to someone else and consider what other careers might be more fulfilling.

So how should you decide on a field to pursue? Whatever your reasons for choosing a specialty, you need to fundamentally enjoy its subject matter, the disease processes, the type of practice, and the patients for whom you will be caring. Ideally, you also want a career that will have longevity.

In making a decision, it is essential that you view your life in the future. Fast forward 20 years. Where do you want to be? How do you hope to be practicing? Find role models who are older than you. Ask them what they like or don’t like about their specialties. Would they make a different choice now that they have a more mature perspective? Many people who practice primary care have great lifestyles and can also practice for a long time because the practice is not the most physically or emotionally rigorous. In general, outpatient medical practice and specialties, which some medical students consider “boring” since they lack the “excitement” of others, allow doctors to work for a long time.

To achieve the same goal, many doctors try to leave the “intense part of their specialty for something less vigorous; for example, orthopedic surgeons may practice solely outpatient sports medicine, and ob/gyns sometimes leave the OR to practice only outpatient gynecology. Emergency physicians may transition from main emergency department work to outpatient urgent care. In deciding on a specialty, do your research, explore how your desired specialty is practiced in many settings and, most of all, be honest with yourself.

JESSICA FREEDMAN, M.D., is president of MedEdits Medical Admissions and author of the MedEdits Guide to Medical Admissions and The Medical School Interview. Follow Dr. Freedman and MedEdits on Facebook and Twitter.

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